MEDICARE: VIVIAN SHEPHERD RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-25-86258	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801544572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN SHEPHERD RBT

Provider Business Mailing Address
First Line	:	1060 SALLY ST SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-5303
Country	:	US
Telephone Number	:	321-626-4425
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 SALLY ST SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-5303
Country	:	US
Telephone Number	:	321-626-4425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2022
Last Update Date	:	12/08/2025

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Directions to “ VIVIAN SHEPHERD RBT” Practice Location

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